HomeMy WebLinkAbout1623 .
Declaratio~ ot Dornicile and Citizenship
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TO TNE STATE AND COUNIY TAX ASSCSSOR, _
51. WCIE COUNTY, FLORIOA:
This is my declarotion of Uomicile and Citizenship in the State of Florida that I am filing this day in accordance and
in confo~mity with Chapte~ 222, Section ~~2.17, Florida Statutes. .
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1 was formerly a legal resident of
(City) . (State)
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end 1 resided at . However 1 have changed my domiule
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to and am and have been a bona fide resident of the State of florida since a day of
~ , 19 -3, and 1 reside ~at . ~ ~
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FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this stateme~t is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts,. such as saie of property or business, or relinquishment of errlployment
at fornner domicile, removal of family to new domicile, purchase of home, etc.)
Applying~ for Homestead ~ ~ .
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- Entering children in school :
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1 FURTHER CERTIFY that 1 wil) comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domic,ile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanenfly. '
.•''.;ti~-,- 'C••. ~ (Name)-
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:5wo~r~ ~tg anil iubscribed before me this day of ~ . , 19~. ~
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ROGER POITRAS
CL CIRCUIT CO RT Noiary Public
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dy ~ D.C. My Commission expires
~ (To be oxocuted in duplicate and oric~inal filedOwRith Clerk Circuif Cou~t, and duplicato with Tax Assessor.)
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